Elsevier

Transplantation Proceedings

Volume 32, Issue 7, November 2000, Pages 2219-2220
Transplantation Proceedings

Liver—clinical experience
Primary graft dysfunction after liver transplantation

https://doi.org/10.1016/S0041-1345(00)01642-0Get rights and content

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Materials and methods

Primary adult OLTs (n = 322) with complete donor and recipient data (taking place from January 1986 to January 1999) were included in this study. IPF was defined as AST > 2000 IU/L on day 1 post-OLT,4 and PNF was defined according to criteria described by Ploeg et al.5 Potential risk factors assessed in this study included recipient age and pretransplant status, graft ischemic time (GIT), steatosis and donor factors (age, cardiac arrest, ICU stay > 5 days, inotropes, hypotension, alcoholism,

Results

PDF occurred in 98 (30.4%) cases in this series. Three (0.93%) cases were PNF, two of which involved grafts of severe steatosis. There were 95 (29.5%) cases of IPF. In the regression analysis, moderate (P = .009) and severe (P = .026) steatosis, and GIT (P = .022) were found to be independent significant risk factors for IPF. Other traditionally known “adverse” factors, including donor age > 50 years, high-dose inotropes, ICU stay > 5 days, cardiac arrest, hypotension, and recipient

Discussion

In the recent era of transplantation, improved retrieval technique, donor ICU care, and graft preservation has optimized the graft condition and thus reduced the negative impact of many traditionally known donor adverse factors. The more standardized transplant surgery and better intraoperative anesthetic support now available have meant that more poor-risk recipients can survive OLT. More effective immunosuppression has reduced post-Tx morbidity and mortality. It is therefore not surprising

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    Moreover, they are simple and dependable (ie, when IPF is suspected, the physician can be alerted to take measures to prevent PNF). Many studies have reported the rates of IPF and PNF to be 22% and 6%, respectively, Nanashima et al reported them to be 18.3% and 4.3%, respectively; Ardite et al14 19% and 0%, respectively; Chui's15 29.5% and 0.93%, respectively, and Chen's3 36.25% and 1.3%, respectively. We observed the rates to be 24.7% and 7.2%, respectively, which showed higher rate of PNF in our study (Table 6).

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    Many studies have reported the rates of IPF and PNF to be 22% and 6%, respectively. Nanashima et al7 reported the IPF and PNF rates of 18.3% and 4.3%; Ardite et al,13 19% and 0%; Chui et al14 29.5% and 0.93%; and Chen et al3, 36.25% and 1.3%, respectively. We observed 24.7% and 7.2% rates of IPF and PNF, respectively.

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